Dr. Dean Edell Statement on Circumcision

By Dean Edell, M.D.
I have had a long and vociferous opposition to the practice of routine male circumcision.

While many parents in the 60s, in their zeal to return to nature, abandoned the practice, it was 15 years ago that the birth of my fourth son prompted my rethinking of the issue (my first three sons were circumcised). I had met a nurse, Marilyn Milos, who is now the president of the National Organization of Circumcision Information Resource Centers, who enlightened me to the existing medical data.

The United States was the only country in the world that routinely circumcised its newborn males. It was a uniquely American ritual. The medical evidence never convinced all the other civilized countries in the world. This did not seem to alter the opinions of medical organizations in the United States. They stubbornly clung to the old myths about circumcision.

After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics issued new recommendations (1999) saying that they do not recommend circumcision as a routine procedure. This is too little and too late for the millions of infants who have undergone this unnecessary and inhumane assault.

This is a radical departure for American medicine and, of course, raises many, many issues. With that statement, the American Academy of Pediatricians joins major national pediatrics groups in England, Australia, Canada, Asia and Europe.

COMMON MYTHS

Let's first talk about the many myths that one hears.

CLEANLINESS

The most common myth is that it's cleaner to be circumcised. It's hard to imagine how this has persisted in an era of soap and running water. But certainly it's understandable that people do get upset with moist places in the body.

A woman's reproductive tract is certainly moist and contains lots of bacteria, yet no one would suggest circumcising females to make them cleaner. Intact boys and children have nothing to 'clean' and a post-puberty man can rinse his penis just as he would wash any other part of his body, and just as a woman washes her genitals.

CERVICAL CANCER

The idea that women who have sex with intact men will get cervical cancer is a myth that is hard to put to rest.

This is so untrue that the Academy did not even consider this in their new evaluation. Cervical cancer is sometimes caused by a virus and has nothing to do with the circumcision status of the male.

URINARY TRACT INFECTIONS

Some studies have found urinary tract infections to be more common in the intact male baby during his first 12 months of life. Other studies have challenged that with findings that demonstrate the opposite to be true - UTIs are higher at any age among circumcised men.

If one accepts the claims of those who think keeping infants intact increases the risk, then you would have to do 200 circumcisions to prevent one urinary tract infection.

COMPLICATIONS

The complication rate of the circumcision operation itself - from bleeding to amputation of the penis - is at least one in 100 according to the American Academy of Pediatrics.

PENILE CANCER

When it comes to penile cancer, the Academy notes that it is so rare that it should not be a significant influence on the decision to circumcise. Body organs that are not amputated may get cancerous cells in them (the breasts, the lungs, and the skin, are organs that are notorious for developing cancers, yet we do not routinely amputate them from our infants). The penis and the prepuce (foreskin), however, are organs that rarely ever become cancerous. An intact man has a greater likelihood of breast cancer than he does penile cancer.

STDs

Sexually transmitted diseases (STDs) have been claimed to be more common in the intact male. But research does not support this myth.

There is no doubt, as the AAP says, that behavioral factors the important factor in determining your risk of STDs and that there are several sexually transmitted diseases that are more common among circumcised men.

FATHER TO SON

The most common reason men give for circumcising their sons is so they will have penises that 'match'. This is simply a poor reason to do such a thing to a newborn baby.

DIFFERENCES: SEXUAL SATISFACTION OF WOMEN

Recent studies have found that sexually, circumcised men are different from intact men. The glans or tip of the intact penis is more sensitive in nerves that give and receive messages from the brain. A man is more able to 'control' his sexual functioning when he remains intact. Circumcision removes the equivalent of 15 square inches of skin, smooth muscle, glands, vessels, and membranes in the adult male. Studies recently (1999) published in the British Journal of Urology found that intact men are more satisfying to their female lovers than circumcised men.

HISTORY

Circumcision was initially introduced into this country by reformers who wanted to prevent masturbation, but according to recent studies, if this was the objective, the reformers have failed.

PREVENT MASTURBATION?

Research published in the Journal of the American Medical Association found that men who are circumcised are more likely to masturbate and to prefer certain sexual practices including oral sex and anal sex. Sexuality meta-analysis studies show that circumcised men masturbate more frequently, and for longer durations, than their intact peers.

It is possible that the decrease in penile sensation that accompanies circumcision could be playing a role in the seeking of different sexual practices that offer more stimulation.

ETHICS

Ethically, the AAP walks a fine line. While they admit that parents and physicians have an ethical duty to act in a child's best interest and well being, they fall far short of recommending that we have an ethical duty to leave a child's genitals intact.

It seems clear to everyone that female circumcision is a gross and obvious violation of this right to genital integrity, but somehow male circumcision is not seen as extreme an intrusion. The AAP does say that, "parents should not be coerced by medical professionals to make this choice."

PAIN

The pediatricians finally admit the obvious: newborns experience extreme pain and significant stress during a circumcision which, unfortunately, is performed most of the time without any analgesia whatsoever.

Why it's taken so long for pediatricians to admit this obvious fact is a clear condemnation of previous circumcision policy. When I was in medical school, doctors tried to teach me that babies don't feel any pain.

SCOPE OF IMPACT

Although it's hard to get numbers, the best that we have tell us that 32 percent of newborns are circumcised in the United States with much lower rates in the West, and slightly higher rates in the Midwest. It's estimated there are 1.2 million newborn males circumcised in the U.S. every year at a cost of between $150 to 270 million. Physicians take in $300-$800 per circumcision surgery.

WHY DO WE PAY?

It seems that, with this newest information, HMO's and other health insurers should stop paying for this medically unnecessary procedure and use that money for other, more important aspects of pediatric care. In fact, in some states, insurance no longer covers circumcision, which is now considered to be cosmetic surgery.

Internationally about 89 percent of the male population is intact. The AAP was not the first developed nation in the West, but the fourth major medical society here to change its circumcision policy. Australia, the U.K., and Canada already had instituted humane policies. Hopefully, we will go much further toward stopping this barbaric practice which is decidedly unhealthy for us and our children.

Lack of research, lack of religious knowledge is what continues this religious ritual. And yes, it is very religious, whether a person claims Christianity, Judaism, Islam, or Atheism as their religious status.

There are no words to describe the feeling I felt while watching that video of the circumcision. I won't ever forget that. I agree with Sarah, everyone needs to watch this!! While I was watching, I thought of my sister who had her boy circumcised, but "couldn't handle" taking him to the surgery, so her husband did it instead. I wasn't educated on circumcision at the time, but I remember thinking something like, "Well, why have it done if you don't agree with it then?" And I thought I was anti-circ before this, but I am angry now. This can't happen and shouldn't happen to those poor, suffering babies. There's no way that will ever EVER happen to my sons.

The time is now to take a historic stand in the U.S. to really end this perverse practice. Those about to make new recommendations must realize they must be on the right side of American medical history because of the human rights and social justice aspect. Hopefully more males are waking up especially and saying no more to the torture and indignity.

I had to skip most of the circumcision procedure b/c I just can't handle it. I caught the very end, where he had the foreskin pulled mostly off and he was cutting it, and I literally screamed in horror!! It is one of the most horrible things I can think of, and I cannot believe it is legal! I have one girl and three boys, and they were ALL born perfect, and I left them just as God created them!!

I was able to watch the entire video, though it was my second time seeing as I had majored in biology in school and was forced to watch it in a developemental biology course. The only thing that I really have to say is how one sided all websites are. I am having a son and have researched everything from how I want him brought into this world to circumcision. I have researched both sides of every aspect and wish a website would give up to date accurate information. Different pediatricians do things differently and everyone should always speak with their choosen pediatrician before making any medical decision, wether it is involving circumsion or any other "mundane" procedure that you child will be enduring. You should never allow one source to influence your decision as well, speak with your doctor then do your own research online. Check out the sites for the search as well as sites against the search. Always remember that you are the best person to decide what is right for your baby, since the dawn of time women have been having children and no one knows that child like the childs mother and father. Any and all decisions should be made together. I felt compelled to write this because all the responses seemed as one sided as the statement, which I expect the one sided statement not such cut and dry statements from the readers. My husband and I made our decision about our son before I had come across this site and we had both seen a circumsion through a video and spoke with all personel that would do the procedure if we had choosen to have it. I recommend all other families to do the same. Again there is no right or wrong answer to having the procedure done or not, it is what YOU choose for YOUR son. Americans tend to follow trends no matter what is best, all it takes is one famous or influental person to start the band wagon and we americans flock to it. For example, research episiotomies and why they should or shouldn't be done during labor! They are slowly becomming the abnormal thing to do, but they were the hit because we as americans so nievely just said yes because we were told it was the best thing to do. Bottom line is to always do your own research.

I fully agree that parents need to research every decision made for their child.

When it comes to keeping healthy newborn babies intact however, (i.e not performing unnecessary surgical amputations on healthy organs) there does not exist the same 'pro-con' list of items to consider. As Edell (and all other informed physicians are aware) there are *no* 'pros' to amputating the prepuce from girls or boys. It is a very valuable, important organ that serves vital functions in both infancy (protection, immunity, etc.) and adulthood (sexuality, protection, functioning). To amputate this organ from a non-consenting minor, when s/he can never again get it back, is obviously problematic.

There is a great deal of scholarly research on this subject. But digging into it, you will always find the same to be true - data that favors intactivism. This is likely why we always see sites that are 'one side or the other' -- if someone does not benefit ($$) from the surgical amputation of the prepuce, then all research suggests it is a harmful practice to continue.

I'd encourage you to check out some more of the literature published (not just online) on the topic. Books are linked here: http://www.drmomma.org/2010/01/are-you-fully-informed.html

Anon - you seem very nice and I applaud you for doing so much research and not just going with the flock mentality but this is NOT a parental decision! If someone broke into a man's home and cut off his foreskin that person would be arrested. Why? Because it is a violation. Cutting off a part of a newborn baby's penis is in no way a parent's choice, it's that boy's decision that he can make when he is an adult.

There are places in the world where there is a widespread belief that raping an infant is the cure to HIV/AIDS. Campains are trying to reach the uneducated followers (and perpetrators) of such a belief. Could we argue that it is the choice of the infants parents to lend him/her to be raped by a HIV infected male? Of course not. It is an ethical and human tragedy, committed by parents who does not know better, and so is circumcision - it is not the choice of each parent, but should be a stand of each society to banish the continued practice of such obsolete and erronneus myths, especially when performed within its own health system.

Cutting a girls genitals creates a worldwide outcry, yet we send our tiny sons to have this archaic, brutal procedure thinking we are doing well by him. It has to stop. Are we really to think that our boys need immediate surgery after birth? They need to be altered somehow? Tell your friends and neighbors that the current circumcision rate is below 32% now, and that if they are worried about how their son looks in the locker room it is more likely he will be "different" because he IS circumcised than that he is not.